Whether the global ‘smart home healthcare’ market actually totals $30bn by 2023, as a Research and Markets study trumpets, is debatable, but one thing that this Editor agrees with is that successful home health devices need to take a chapter from Steve Jobs’ Apple and famed industrial designer Raymond Loewy’s playbooks (search our Loewy references here) and design for how the consumer lives and would use their product. It isn’t flashy design awards, but how that technology can not only fit into a person’s life but also be an asset that they’d miss if someone took it away–a point often forgotten in the rush of initial design, testing, and funding.

Writer Scott Thielman of Product Creation Studio, a Seattle-based industrial design and engineering firm, outlines four health tech products/services that represent technology that is intuitive, easy-to-use, accessible, and, I would add, have a little something extra that makes them indispensable.

Athelas, a next-generation immune monitoring device that resembles an Amazon Alexa in being a 3D black cylinder. Instead of playing music, it measures neutrophils, lymphocytes, platelets, white blood cells, morphology, and cell activation all within minutes from a test strip inserted in the cylinder. (Investigational device awaiting FDA review)

Rochester Institute of Technology (RIT)’s smart toilet seat (which Editor Charles punningly referred to here) was tested with heart failure patients. It measured nine clinically relevant features, including weight, single-lead ECG, systolic/diastolic blood pressure, blood oxygenation and localized pulse timing, and a ballistocardiogram (BCG) for measuring the mechanical forces associated with the cardiac cycle. Normally, the patient would have to use several devices for these measurements rather than taking a seat. Speaking of the seat, it is standard white and replaces the one in the bathroom. Results were published in JMIR mHealth and uHealth.

ResMed’s connection of its continuous positive air pressure (CPAP) sleep apnea treatment devices to the cloud before the patient uses them, plus their patient smartphone app helps them to claim that 84 percent of new users reach the necessary usage threshold for Medicare adherence in the first 90 days of treatment.

Clarify Medical’s build-in of user feedback for its home vitiligo and psoriasis treatment that goes direct to their in-house customer service also registers patient usage, needed fixes, and outreach to those who need additional coaching and training.

Livongo’s acquisition of myStrength’s behavioral health app [TTA 31 Jan] also points to the importance of consumer behavior in a somewhat different aspect–the 20 percent and more who are struggling with behavioral health issues along with one or more chronic conditions managed by Livongo for employers and health plans.

NeuroPace, which developed an implanted brain-responsive neuromodulation system for patients with refractory and drug-resistant epilepsy, announced the result of their nine-year long-term treatment study.

Approximately 3 out of 4 patients responded to therapy, achieving at least 50% seizure reduction

1 in 3 patients achieved at least 90% seizure reduction

28% of patients experienced seizure-free periods of six months or longer; 18% experienced seizure-free periods of one year or longer

Median seizure reduction across all patients was 75% at 9 years

Quality of life improvements (including cognition) were sustained through 9 years, with no chronic stimulation-related side effects.

The study included 256 patients across 33 epilepsy centers with nearly 1,900 patient implant years of follow-up on the RNS System. Release.

It appears that the VA is talking with Apple about a mobile EHR. VA patients would be able to transfer their records to their iPhone — likely through Apple’s Health Records app. No time frame is mentioned and it’s hard to expect a quick turnaround given the VA’s stringent IT and security requirements. Another factor is that VA is making the long transition from VistA to Cerner’s MHS Genesis, bumpily. Mobihealthnews picking up a paywalled Wall Street Journal article.

Medtronic, otherwise known as the 9,000 lb Elephant that Sits Where It Wants, will acquire long-time diabetes partner Nutrino, an AI powered personalized nutrition platform. In June, Medtronic integrated Nutrino’s FoodPrint Report technology that connects meal and glucose variability into Medtronic’s iPro2 myLog app. Terms and timing were not disclosed. It fits in Medtronic’s recent strategy of smaller acquisitions and beefing up its diabetes business. Mobihealthnews.

Zimmer Biomet, a musculoskeletal medical device company, is partnering with Apple to use the Apple Watch with an iPhone 6s and above in tracking the pre-surgery and post-operative recovery process for patients with hip and knee replacements. Zimmer is using the mymobility app developed with Apple to track patient-reported feedback, provide patient education and guidance, and share continuous health and activity sensor-based data with care teams. The aim is to improve the standard of care and patient outcomes after these surgeries.

The mymobility Clinical Study started on 15 October and may enroll up to 10,000 patients with 16 corresponding healthcare facilities including academic health systems, hospitals, and orthopedic surgery centers/practices. No length or end date for the study has been disclosed.

A positive outcome leveraging patient engagement and providing continuous detailed clinical tracking data could have major significance. There are over 1 million hip and knee orthopedic replacements in the US annually, which is expected to increase to 3.5 million by 2035. The average cost of a hip or knee replacement is estimated at about $31,000, varying widely by region, based on a 2015 Blue Cross Blue Shield Association study. Post-surgery complications are common enough so that Medicare.gov tracks them through Hospital Compare.

According to Zimmer, “the mymobility app provides instruction and opportunities for enhanced engagement between the patient and healthcare provider. This mobile application is designed to work with the Apple Watch® wearable companion to remind patients to check their smartphone application daily, to read pre-planned and timed educational information, perform tasks, and complete assigned exercises; understanding their condition and care plan gives patients the ability to actively participate in optimizing their surgical outcome.” For the clinician, it is a communication tool between the patient and care team. “Surgeons use a clinician dashboard to monitor the threshold values and actively observe progress throughout each patient’s journey. Through the adoption of multifunctional sensor technology in the form of a wearable companion on the wrist, mymobility provides the potential to identify metrics that may permit further refinement of pre and postsurgical care.”

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/10/apple-watch-series-4-elektrokardiogram.jpg” thumb_width=”125″ /]Mid-September’s Apple Fanskvelled about the Apple Watch Series 4 debut. Much was made in the health tech press of Apple’s rapid FDA clearance and the symbolism of their further moves into medical devices with the Series 4 addition of a built-in atrial fibrillation-detecting algorithm and an ECG, along with fall detection via the new accelerometer and gyroscope.

This latter feature is significant to our Readers, but judging from Apple’s marketing and the press, hardly an appealing Unique Selling Proposition to the Apple FanBoys’n’Girls who tend to be about 35 or wannabe. The website touts the ECG as a performance feature, a ‘guardian and guru’ topping all the activity, working out, and kickboxing you’re doing. It positions the fall detection and Emergency SOS in the context of safety during or after hard working out or an accident. It then calls 911 (cellular), notifies your emergency contacts, sends your current location, and displays your Medical ID badge on the screen for emergency personnel, which may not endear its users to fire and police departments.

Laurie Orlov in her latest Age In Place Tech article points out the disconnect between the fall risk population of those aged 70+ and the disabled versus the actual propensity (and fisc) to buy an Apple Gizmo at $400+. PewInternet’s survey found that 46 percent of those over 65 actually own a smartphone, though this Editor believes that 1) much less than 50 percent are Apple and 2) most smartphone features beyond the basic remain a mystery to many. (Where store helpers, children, and grandchildren come in!)

Selling to older adults is obviously not the way that Apple is going, but there may be a subset of ‘young affluent old’ who want to sport an Apple Watch and also cover themselves for their cardiac or fall risk. (Or have children who buy it.) This is likely a sliver of a subset of the mobile PERS market, which is surprisingly small–only 20 percent of the total PERS market. But monitoring centers–doubtful, despite it being lucrative for GreatCall.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/11/jacobs-well-texas-woe1.jpg” thumb_width=”150″ /]Did Elizabeth Holmes ‘misunderstand’ Steve Jobs’ methods or was there something more deliberate at work? This article by tech entrepreneur Derek Lidow in Forbes gives her the benefit of the doubt but is still damning. His points in summary are:

Holmes ran Theranos with zero knowledge of how to run an organization, and ran Theranos like a dictator. Hiring people with real expertise came late in the day, and most of them left once they realized her style. Jobs knew he couldn’t run a company, generally hired the right people to do so, and then let them run it.

Jobs teamed with a genius engineer named Steve Wozniak in Apple’s formative years, and the Woz guided Jobs as much as anyone at numerous critical stages. Woz was the balance to Jobs, the behind the scenes versus the on-stage. Holmes did not work with anyone in that way, which is atypical for startup founders. Her co-founder was unqualified, she didn’t listen to her staff as problems came up, and her board was a waste of titles and people who were either wholly capable in other fields or superannuated.

Holmes’ goal of mini-blood assays was impossible, and she was unlike other visionary founders to pivot to what was possible. Jobs tempered his vision by using methods and technologies which already existed to leverage Apple into what he envisioned. (Jobs also had his fair number of stumbles, such as the Newton tablet where the vision exceeded the available technology. It was also too advanced, violating the Raymond Loewy maxim of ‘most advanced yet acceptable’.)

Delighting the customer? Where Jobs excelled in this not only with end users but also with developer partners, Holmes failed and more. With deceptive blood testing, she hurt sick patients and doctors who depended on accuracy. The vision and her self-promotion were far more important. She wasn’t doing this for people–she was doing this for herself.

Holmes was over the top on compartmentalizing Theranos’ technical development, straight to failure. Teams on the same project didn’t share knowledge or fundamentally communicate with each other. This led to bad testing of only parts of the system, not the whole system. While Jobs kept a tight lock on exposing Apple developments until they were ready, department teams on a given project intensively shared information.

Wearing the black turtleneck, being a young female, blond, and with enhanced blue pop-eyes akin to a Bug-Eyed Austin-Healey Sprite can get you noticed, but then you have to deliver the goods for that $900 million you raised. Holmes was inexperienced and psychologically ill-equipped to be a tech founder. This Editor also wondered if she (literally) garbed herself in Jobs’ exterior trappings to deceive and gull everyone from the mighty and rich to the ordinary and often sick. (And now she tells people she is a marytr akin to Saint Joan?)

9 to 5 Mac, the tip sheet for all things Apple, tracked down a patent granted to Apple (via Patently Apple) for computing health measurements using the iPhone. According to Apple in the patent, “electrical measurements may be used to measure heart function, compute an electrocardiogram, compute a galvanic skin response that may be indicative of emotional state and/or other physiological condition, and/or compute other health data such as body fat, or blood pressure.” It would use the front-facing camera, light sensor and proximity sensor to emit light that would be reflected back to the sensors. Additional sensors mounted in the same area would also generate additional health measurements such as body fat and EKG, which is already measured by the Kardia Mobile/Alivecor attachment. The camera and light sensor alone, based on the patent and the article, would measure oxygen saturation, pulse rate, perfusion index and a photoplethysmogram (which can monitor breathing rate and detect circulatory conditions like hypovolemia). Another demonstration of Apple’s keen interest in the health field, but what features will show up on real phones and apps–and when?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/07/Fitbit-smartwatch.jpg” thumb_width=”200″ /]Fitbit’s ‘Project Higgs’ in-house designed smartwatch is, by all reports, on schedule to hit the market later this year in time for the holidays, at least in Wall Street’s expectations. To the FT (may be paywalled) CEO James Park reassured, “The product is on track to meet our expectations and the expectations that we’ve set for investors. It’s going to be, in my opinion, our best product yet.” It will be waterproof, a battery that lasts several days, have mobile payment capability (from the Coin acquisition), simple health tracking, heart rate monitor, sleep tracking, stream music (Spotify and Pandora are rumored), and its own app store. It will be either Wi-Fi or smartphone connected. TechRadar’s agglomeration of rumors include pricing ($199 to $299 –about £231), swappable bands, a full-color screen with 1,000 nits of brightness, an aluminum body and built-in GPS. The most interesting part is the proprietary operating system which uses Javascript. Also Pocket-Lint articles 18 July and 19 July.

Intel, however, is giving up the smartwatch and fitness tracking chase. In 2014 they acquired Basis in a well-publicized move and enlisted hip celebrities like 50 Cent to endorse their products versus the likes of Apple and Fitbit. In November about 80 percent of the group was let go, according to CNBC, and entirely eliminated this month. The New Technologies Group is now focusing on augmented reality. CNBC

There have been sketchy reports of Fitbit’s CEO James Park meeting with the NHS last month to get Fitbits into the ‘big moves’ in wearables and apps promised by Health Secretary Jeremy Hunt. Mr. Park’s interview with the Sunday Times (limited access) indicated that Fitbit’s NHS project, should it happen, would be for exercise and activity monitoring, similar to the partnership with UnitedHealthcare which reduces premiums based on policyholder exercise monitoring. This move towards payers is in line with reports starting last year of Fitbit’s seeking clinical markets and moving away from the fickle B2C market. City AM

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/05/Fitbit-Watch-FINAL.jpg” thumb_width=”150″ /]Given this week’s leak/reveal and scuttlebutt on the new Fitbit smartwatch, Mr. Park needs to gin up a big payer, quickly. The advance buzz is not positive nor kind. It’s delayed from spring to end of year–in competition with the latest iteration of the Apple Watch. This advance photo of codenamed ‘Higgs’ from Yahoo!Finance indicates a certain clunkiness (and derivation from the panned semi-smartwatch Blaze). It’s pricey, rumored to be priced at around $300. Features include a 1,000nit, built-in GPS, heart-rate monitoring, contactless payments, Pandora and four days of battery life along with connectivity to new Bluetooth headphones. Yet TechCrunch notes “complaints about design, production delays, antenna issues and software problems.” in what they dub “a giant mess”. Forbes notes problems in waterproofing and GPS signal. There are other Android-based smartwatches that do the same for the same price or less. Will this save Fitbit? To be determined….

Update:CEO Park denies delays in the new smartwatch, saying “all new product introductions are on track”, but then again–it hasn’t been officially announced! On the earnings call Thursday, Fitbit stated that new products are now accounting for 84 percent of 1stQ revenue. The company also reported better-than-expected earnings for the first quarter of 2017, reporting an adjusted loss of 15 cents per share on revenue of $299 million. Full year projected at $1.5 – 1.7 bn. Marketwatch, The Verge

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/02/Hackermania.jpg” thumb_width=”150″ /]Get out the Ransom! California hospitals appear to be Top of the Pops for ransomware attacks, which lock down and encrypt information after someone opens a malicious link in email, making it inaccessible. After the well-publicized attack on Hollywood Presbyterian in February, this week two hospitals in the Inland Empire, Chino Valley Medical Center in Chino and Desert Valley Hospital in Victorville, both owned by Prime Healthcare Management, received demands. While hacked, neither hospital paid the ransom and no patient data was compromised according to hospital spokesmen. Additional hospitals earlier this month: Methodist Hospital in Henderson, Kentucky and Ottawa Hospital in Ontario, Canada. In Ottawa, four computers were hacked but isolated and wiped. It is not known if ‘Locky’, the moniker for a new ransomware, was the Canadian culprit. FBI on the case in the US. HealthcareITNews, National Post

Update: Locky is the suspected culprit in the Prime, Hollywood Presbyterian and Kentucky ransomware attacks. On Monday, Maryland-based MedStar Health reported malware had caused a shutdown of some systems at its hospitals in Baltimore. Separately, Cisco Talos Research is claiming that a number of the attacks are exploiting a vulnerability in a network server called JBoss using a ransomware dubbed SamSam. Perhaps both are creating mischief? Ars Technica, Cisco Talos blog, BBC News, ThreatPost

More and worse attacks north of the 49th Parallel. Norfolk General Hospital in Simcoe, Ontario had a ransomware attack this week that spread to computers of staff, patients and families via the external website through the outdated content management system. According to MalwareBytes, “The particular strain of ransomware dropped here is TeslaCrypt which demands $500 to recover your personal files it has encrypted. That payment doubles after a week.” So if you are running old Joomla! or even old WordPress, update now! Neil Versel in MedCityNews

If you’re thinking Mac Prevents Attacks, the first ransomware targeting Apple OS X hit earlier this month. Mac users who downloaded version 2.90 of Transmission, a data transfer program using BitTorrent, were infected. KeRanger appears after three days to demand one bitcoin (about $400) to a specific address to retrieve their files. HealthcareITNews

Finally, there is the Hackermania gift that keeps on giving: Healthcare.gov.(more…)

The Royal Society of Medicine has it’s fifth annual medical app conference on April 7th – numbers booked have already well exceeded last year’s sellout so they are expecting to fill this year’s much larger conference venue. The focus this year is on the many legislative, regulatory and voluntary measures being introduced that will impact medical apps – there’s still room for old favourites though, such as Richard Brady’s always-topical (more…)

We begin with news of the first CE certified mole checking app, SkinVision which rates moles using a simple traffic light system (using a red, orange or green risk rating). The app lets users store photos in multiple folders so they can track different moles over time. It aims to detect changing moles (color, size, symmetry etc.) that are a clear sign that something is wrong and that the person should visit a doctor immediately.

This contrasts with the findings of a paper published in June examining 46 insulin calculator apps, 45 of which were found to contain material problems, resulting in the conclusion that :”The majority of insulin dose calculator apps provide no protection against, and may actively contribute to, incorrect or inappropriate dose recommendations that put current users at risk of both catastrophic overdose and more subtle harms resulting from suboptimal glucose control.”, which to say the least of matters is worrying. (more…)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/08/ResearchKitApps-640×360.jpg” thumb_width=”150″ /]On Thursday, Stamford University released MyHeartCounts, the first iPhone health app using the AppleResearchKit platform. Initial launch is in the UK and Hong Kong. It is designed to study factors around heart health by collecting data about physical activity and cardiac risk factors. Every three months, participants monitor one week’s worth of physical activity and also complete a 6-minute walk fitness test. The latest version of the app also includes feedback on users’ behaviors and risks. While the initial phase of the MyHeart Counts study both collects heart health data and provides personalized information to participants, the next phase will be to study motivational tools for users. Currently 41,000 participants have registered for this study. Medaxs via eHealthSpace.org (both Australia)

And it’s not for sale. The life sciences group within Google X is testing on small groups a wrist-worn device which can sense with high accuracy pulse, heart rhythm, skin temperature and environmental information like light exposure and noise levels. Bloomberg News, which appears to have broken the story, quotes Andy Conrad, head of the life sciences team at Google: “Our intended use is for this to become a medical device that’s prescribed to patients or used for clinical trials.” Obviously it will be more accurate both in hardware and in back end algorithms than what’s currently marketed via Android Wear for smartwatches. Perhaps this is meant for the ‘superusers’ of healthcare services at the top 5 percent using 50 percent of spend, the new ‘It Girls’ of healthcare, TTA 28 May)? However, he’s also projecting out 20-30 years, so health systems and researchers, do not hold your breath waiting for this to become reality. (This is also a counter to Apple’s ResearchKit.) Also Yahoo Finance and The Verge, which has a gigantic photo of a smartwatch but no caption attribution. The Verge also mentions their research in MS. Gizmodo also adds that Mr Conrad is directing the Google X Baseline project, which is doing human testing and crunching data to develop a baseline of normal human health.

More about Google X in this video interview on Tested with Astro Teller (for real), ‘captain of moonshots’ for the company, on ‘thinking big and failing quickly’. (24 minutes)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/04/IBM-Watson-Announcement.jpg” thumb_width=”200″ /]A Day with a Big Exclamation Point for Healthcare Data and Analytics. In a series of press releases late NY time on Monday and a spectacular announcement at HIMSS (photo hat tip to Sandeep Pulim via Twitter), the recently quiet-on-the-healthcare-front IBM Watson has announced multiple major moves that re-position it squarely into the healthcare arena as the 90,000 lb. Elephant.

IBM Watson Health is now a separate business unit headquartered in Boston. The Watson New York headquarters will be expanded, but that may be for their other businesses: travel, retail, veterinary care, cognitive computing, and IT security and support. IBM claims that Watson Health will be hiring up to 2,000 healthcare consultants, clinicians and researchers, folding in existing units such as Smarter Care and Social Programs.

The IBM Watson Health Cloud is now their secure, open and HIPAA compliant platform for health-related data: physicians, researchers, insurers and health and wellness companies.

Three new partnerships were announced, designed to bolster IBM in different aspects of what is to be done with All That Data being generated from health and fitness devices. IBM Watson Health Cloud will be the secure platform, storage and analytics for Apple’s HealthKit and ResearchKit. Johnson & Johnson will be working with Watson on pre/post-operative coaching and education and Medtronic on diabetes management using data from Medtronic devices. (more…)

The Association of British Healthcare Industries (ABHI) is looking for companies to share the British Pavilion at the CMEF trade show from 15th – 18th May 2015 in Shanghai, China. It is apparently the the leading Healthcare trade show in China and is now the largest Medical Equipment exhibition in the Asia Pacific region attracting over 60,000 visitors. Details here.

Still need to see some more predictions for 2015? – try these 12 for telecoms, which does include the odd interesting nod towards subjects we cover, including interconnection of wearables and connected homes.

Prompted by our mention of V-Connect in our review of our 2014 predictions, MD Adam Hoare has pointed out that his company also won the Medilink ‘partnership with the NHS’ award for their renal project with The Lister Hospital in Stevenage. Congratulations!

As intimated in our review of last year’s predictions, we feel little need to change course significantly, however some are now done & dusted, whereas others have a way to go. The latter include a concern about doctors, especially those in hospitals, continuing to use high-risk uncertified apps where the chance of injury or death of a patient is high if there is an error in them. Uncertified dosage calculators are considered particularly concerning.

Of necessity this is an area where clinicians are unwilling to be quoted, and meetings impose Chatham House rules. Suffice to say therefore that the point has now been well taken, and the MHRA are well aware of general concerns. Our first prediction therefore is that:

One or more Royal College/College will advise or instruct its members only to use CE-certified or otherwise risk-assessed medical apps.

The challenge here of course is that a restriction to CE-certified apps-only would be a disaster as many, if not most, apps used by clinicians do not meet the definition of a Medical Device and so could not justifiably be CE-certified. And apps are now a major source of efficiencies in hospitals – (more…)

Our definitions

Telehealth and Telecare Aware posts pointers to a broad range of news items. Authors of those items often use terms 'telecare' and telehealth' in inventive and idiosyncratic ways. Telecare Aware's editors can generally live with that variation. However, when we use these terms we usually mean:

• Telecare: from simple personal alarms (AKA pendant/panic/medical/social alarms, PERS, and so on) through to smart homes that focus on alerts for risk including, for example: falls; smoke; changes in daily activity patterns and 'wandering'. Telecare may also be used to confirm that someone is safe and to prompt them to take medication. The alert generates an appropriate response to the situation allowing someone to live more independently and confidently in their own home for longer.

• Telehealth: as in remote vital signs monitoring. Vital signs of patients with long term conditions are measured daily by devices at home and the data sent to a monitoring centre for response by a nurse or doctor if they fall outside predetermined norms. Telehealth has been shown to replace routine trips for check-ups; to speed interventions when health deteriorates, and to reduce stress by educating patients about their condition.

Telecare Aware's editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.